Main Drugs Used Flashcards
Adrenaline
indications
Croup (with stridor at rest)
Severe or life threatening bronchospasm (speaking in single words/ALOC/haemodynamic compromise)
Cardiac arrest
Anaphylaxis or severe allergic reaction
Bradycardia with poor perfusion (unresponsive to atropine or TCP)
Shock unresponsive to adequate fluid resus
Adrenaline
contraindications
Nil
Adrenaline
precautions
Current MAOI therapy
Hypertension
Hypovolaemic shock
Adrenaline
side effects
Tremors Anxiety Palpitations/Tachycardia Hypertension Pupil dilation
Adrenaline
Dosage for cardiac arrest
IV (ACP, CCP)
1mg every 3-5 minutes
No max dose
IO (CCP)
1mg every 3-5 minutes
No max dose
Adrenaline
Dosages for anaphylaxis or severe allergic reaction
IM (ACP1, ACP2, CCP) 300 mcg, repeat at 5 min No max dose NEB (ACP2, CCP) - for facial or tongue swelling 5mg single dose IV/IO (CCP) 20-50 mcg, repeat at 1 min intervals No max dose
Adrenaline
Dosages for severe to life threatening bronchospasm
IM (ACP1, ACP2, CCP) 300 mcg every 5 min No max IV/IO (CCP) 20-50 mcg every 1 min No max
Aspirin
Indications
Suspected ACS
Acute cardiogenic pulmonary oedema
Aspirin
Precautions
Use of other anticoagulants (e.g. Warfarin)
Hx of GI bleed or peptic ulcer
Aortic aneurysm or other condition that may require surgery
Pregnancy
Aspirin
Side effects
GI bleed Epigastric discomfort/pain Nausea/vomiting Gastritis NSAID induced bronchospasm
Aspirin
Dosages
PO (ACP1, ACP2, CCP)
300mg single dose
Max dose 450mg
Aspirin
Onset, duration and half-life
Onset: approx 10 min
Duration: 1 week
Half life: 3.2 hours
Ceftriaxone
Indications
Suspected meningococcal septicaemia (with non blanching petechia and/or purpuric rash)
Ceftriaxone
Containdications
KSAR or hypersensitivity
Known anaphylaxis or severe allergic reaction to penicillin based drugs
Ceftriaxone
Precautions
Nil
Ceftriaxone
Side effects
Nausea/vomiting
Pain at IM injection site
Ceftriaxone
Adult dosages
IM (ACP1, ACP2, CCP)
1g single dose
Syringe preparation - reconstitute in 3.6mL of water in 10mL syringe
IV (ACP2, CCP) IO (CCP)
1g single dose - Slow push over 3-5 minutes
Syringe preparation - reconstitute in 10mL of water in 10mL syringe
Fentanyl
Indications
Significant pain Autonomic dysreflexia (SBP >/= 160mmHg) Sedation for maintenance of established LMA or ETT
Fentanyl
Contraindications
KSAR or hypersensitivity
Fentanyl
Precautions
Elderly Hypotensive Concurrent MAOI therapy Respiratory tract burns Respiratory depression/failure Known narcotic addiction
Fentanyl
Side effects
Pinpoint pupils Nausea/vomiting Bradycardia Hypotension Drowsiness Respiratory depression
(Not morphine) muscular rigidity - especially respiratory muscles
Fentanyl
Onset, duration, half-life
Onset: (IV)
Fentanyl
Dosages for significant pain and autonomic dysreflexia (ACP2 +)
IM (ACP1, ACP2, CCP) >70 years 25mcg Repeat at up to 50mcg every 5 min Total max dose 100mcg 70 years 25mcg Repeat at up to 25mcg every 5 min Total max dose 100mcg
Glucagon
Indications
Symptomatic hypoglycaemia
Glucagon
Contraindications
KSAR or hypersensitivity
Glucagon
Precautions and side effects
Nil
Glucagon
Onset, Duration and Half-life
Onset: 4-7 min
Duration: variable
Half-life: 3-6 min
Glucagon
Dosages
IM (ACP1, ACP2, CCP)
1mg single dose
Reconstitute with 1mL water in 3ml syringe
Glucose 10%
Indications
Symptomatic hypoglycaemia
Glucose 10%
Contraindications
Precautions
Side effects
Contras - nil
Precautions - hyperglycaemia
Side effects - nil
Glucose 10%
Dosages
IV (ACP2, CCP) IO (CCP)
15g (150ml)
Repeat at 100ml boluses every 5 min until BGL >4mmol
Glucose Gel Indications Contraindications Precautions Side effects
Indications - symptomatic hypoglycaemia
Contras - age
Glucose gel
Onset
Approx 10 min
Glucose gel
Dosages
PO (ACP1, ACP2, CCP)
15g
Repeat once at 15 min of BGL less than 4mmol/L
Total max dose 30g
GTN
Indications
Suspected ACS (with pain) Acute cardiogenic pulmonary oedem Autonomic dysreflexia (SBP >160) Irukandji syndrome (SBP >160)
GTN
Contraindications
KSAR
HR >150 or
GTN
Precautions
Use of phosphodiestase inhibitors in last 48 hours Cerebrovascular disease Suspected inferior AMI Risk of hypotension and/or syncope Intoxication
GTN
Side effects
Hypotension Reflex tachycardia Vascular headaches Dizziness Syncope
GTN Adult dosages (all indications)
Sublingual (ACP1, ACP2, CCP)
400mcg
Repeat at 5 min
No max
Also CCP IV infusion for suspected ACS
Ipratropium Bromide
Indications
Moderate or severe bronchospasm
Ipratropium Bromide
Contraindications
Age
Ipratropium Bromide
Precautions
Glaucoma
Ipratropium Bromide
Side Effects
Dilated pupils
Dry mouth
Palpitations
Ipratropium Bromide
Onset, Duration, Half-life
Onset - 1.5-3 min
Duration - 4-6 hours
Half-life - 3 hrs
Ipratropium Bromide
Dosages
NEB (ACP1, ACP2, CCP)
500mcg
Single dose
Methoxyfleurane
Indications
Significant pain
Methoxyfleurane
Contraindications
KSAR or hypersensitivity
Hx of malignant hyperthermia
Hx of significant renal or hepatic failure
Pt
Methoxyfleurane
Precautions
ALOC
Intoxication or drug affected pt
Methoxyfleurane
Side effects
ALOC
Cough
Renal/hepatic failure (following repeat high dose exposure)
Methoxyfleurane
Onset, Duration, half-life
Onset - 1-3 min
Methoxyfleurane
Dosages
Inhaled (ACP1, ACP2, CCP)
3ml
Repeat at 20 min
Midazolam
Indications
Generalised/focal seizures Avute behavioural disturbances (SAT 2 or more) Sedation - maintenance of LMA or ETT - Procedures (TCP or cardioversion) - Adjunct to opioid analgesia - Ketamine emergence - To facilitate safe assessment and treatment of agitated head injured patient
Midazolam
Contraindications
KSAR or hypersensitivity
Midazolam
Precautions
Severe respiratory distress in COPD Myasthenia graves MS Use reduced dose for: - elderly - chronic renal failure - congestive cardiac failure - shock
Midazolam
Side effects
Hypotension
Respiratory depression - especially when used with other respiratory depressants
Midazolam
Adult dosages for generalised or focal seizures
Nasal, IM (ACP1, ACP2, CCP)
>70 years 2.5mg
Repeat every 10 min
Total max, 10mg
IV/IO (CCP)
Same as above, every 5 min
Morphine
Indications
Significant pain Autonomic dysreflexia (SPB >160) Sedation for maintenance of established LMA/ETT
Morphine
Contraindications
KSAR or hypersensitivity
Renal failure
Morphine
Precautions
Elderly Hypotension Known narcotic addiction Respiratory tract burns Respiratory depression/failure Concurrent MAOI therapy Cardiac chest pain
Morphine
Side effects
Pin point pupils Bradycardia Hypotension Nausea/vomiting Drowsiness Respiratory depression
Morphine
Onset, Duration, half-life
Onset - IM 5-10 min, IV 2-5 min
Duration - 1-2 hours
Half-life - 2 hours
Morphine
Dosages for significant pain
IM (ACP1, ACP2, CCP) >70 years 2.5-5mg Repeat at up to 5mg every 10 min Max dose 10mg 70 years 2.5mg Repeat at 2.5mg every 5 min Max dose 10mg
Morphine
Dosages for autonomic dysreflexia
.
Naloxone
Indications
Respiratory depression secondary to administration of narcotic drugs
Naloxone
Contraindications
KSAR or hypersensitivity
Naloxone
Precautions
Pre-existing cardiac disease
Aspirin Contraindications
KSAR
Chest pain associated with psychostimulant OD
Bleeding or clotting disorders (e.g. Haemophilia)
Current GI bleed or peptic ulcer
Patient
Ondansetron Indications
Nausea and/or vomiting
Prophylactic for patient presenting with ACS
Ondansetron contraindications
KSAR to ondansetron or other 5-HT3 receptor antagonists
Congenital long QT syndrome
Patient
Ondansetron adult dosages
IM (ACP1, ACP2, CCP)
4-8 mg - total max 8mg
IV (ACP2, CCP)
4-8 mg - total max 8mg
